Uniform Residential Loan Application Revised



Uniform Residential Loan Application

____________________________________________________________________________________________

This application is designed to be completed by the applicant(s) with the Lender’s assistance. Applicants should complete this form as “Borrower” or “Co-Borrower,” as applicable. Co-Borrower information must also be provided (and the appropriate box checked) when the income or assets of a person other than the Borrower (including the Borrower’s spouse) will be used as a basis for loan qualification or the income or assets of the Borrower’s spouse or other person who has community property or similar rights pursuant to applicable state law will not be used as a basis for loan qualification, but his or her liabilities must be considered because the spouse or other person who has community property or similar rights and the Borrower resides in a community property state, the security property is located in a community property state, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan.

If this is an application for joint credit, Borrower and Co-Borrower each agree that we intend to apply for joint credit (sign below):

________________________________ __________________________________________

Borrower Co-Borrower

|I. TYPE OF MORTGAGE AND TERMS OF LOAN |

|Mortgage Applied | VA USDA/Rural Housing Service |Agency Case Number |Lender Case Number |

|for: |FHA Conventional Other (explain): | | |

|Amount |Interest Rate |No. of Months |Amortization Type: | Fixed Rate | Other (explain): |

|$ |% | | |GPM |ARM (type): |

|II. PROPERTY INFORMATION AND PURPOSE OF LOAN |

|Subject Property Address (street, city, state & ZIP) |No. of Units |

|Legal Description of Subject Property (attach description if necessary) |Year Built |

|Purpose of Loan Purchase Refinance Construction |Property will be: |

|Construction-Permanent Other (explain): |Primary Residence |

| |Secondary Residence |

| |Investment |

|Complete this line if construction or construction-permanent loan. |

|Year Lot |Original Cost |Amount Existing Liens |(a) Present Value of Lot |(b) Cost of Improvements |Total (a + b) |

|Acquired | | | | | |

| | |$ |$ |$ | |

| |$ | | | |$ |

|Complete this line if this is a refinance loan. |

|Year Acquired |Original Cost |Amount Existing Liens |Purpose of Refinance |Describe ( made ( to be made |

| | | | |Improvements |

| | |$ | | |

| |$ | | | |

|Title will be held in what Name(s) |Manner in which Title will be held |Estate will be held in: |

| | |Fee Simple |

| | |Leasehold |

| | |(show expiration date) |

|Source of Down Payment, Settlement Charges, and/or Subordinate Financing (explain) |

|Borrower |III. BORROWER INFORMATION |Co-Borrower |

|Borrower’s Name (include Jr. or Sr. if applicable) |Co-Borrower’s Name (include Jr. or Sr. if applicable) |

|Social Security Number|Home Phone |DOB (mm/dd/yyyy)|Yrs. School |Social Security Number |Home Phone |DOB (mm/dd/yyyy) |Yrs. School |

| |(incl. Area code) | | | |(incl. Area code) | | |

| | | | | | | | |

| Married | Separated |Dependents | Married | Separated |Dependents |

| | |(not listed by Co-Borrower) | | |(not listed by Borrower) |

| Unmarried |no. |ages | Unmarried |no. |ages |

|(include single, divorced, widowed) | | |(include single, divorced, widowed) | | |

|Present Address Own Rent __No. Yrs. |Present Address Own Rent __No. Yrs. |

|(street, city, state, ZIP) |(street, city, state, ZIP) |

| | |

|Mailing Address, if different from Present Address |Mailing Address, if different from Present Address |

|If residing at present address for less than two years, complete the following: |

|Former Address Own Rent __No. Yrs. |Former Address Own Rent __No. Yrs. |

|(street, city, state, ZIP) |(street, city, state, ZIP) |

| | |

| | |

|Borrower |IV. EMPLOYMENT INFORMATION |Co-Borrower |

|Name & Address of Employer| Self Employed |Yrs. on this job |Name & Address of Employer| Self Employed |Yrs. on this job |

| | |Yrs. employed in this | | |Yrs. employed in this |

| | |line of work/profession | | |line of work/profession |

|Position/Title/Type of Business |Business Phone |Position/Title/Type of Business |Business Phone (incl. |

| |(incl. area code) | |area code) |

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

|Name & Address of Employer| Self Employed |Dates |Name & Address of Employer| Self Employed |Dates |

| | |(from – to) | | |(from – to) |

| | |Monthly Income | | |Monthly Income |

| | | | | | |

| | |$ | | |$ |

|Position/Title/Type of Business |Business Phone (incl. |Position/Title/Type of Business |Business Phone (incl. |

| |area code) | |area code) |

|Name & Address of Employer| Self Employed |Dates |Name & Address of Employer| Self Employed |Dates |

| | |(from – to) | | |(from – to) |

| | |Monthly Income | | |Monthly Income |

| | | | | | |

| | |$ | | |$ |

|Position/Title/Type of Business |Business Phone (incl. |Position/Title/Type of Business |Business Phone (incl. |

| |area code) | |area code) |

|V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION |

|Gross |Borrower |Co-Borrower |Total |Combined Monthly |Present |Proposed |

|Monthly Income | | | |Housing Expense | | |

|Base Empl. Income* |$ |$ |$ |Rent |$ | |

|Bonuses | | | |Other Financing (P&I) | | |

|Commissions | | | |Hazard Insurance | | |

|Dividends/ | | | |Real Estate Taxes | | |

|Interest | | | | | | |

|Net Rental Income | | | |Mortgage Insurance | | |

|Other | | | |Homeowner Assn. Dues | | |

|(before completing, see | | | | | | |

|the notice in “describe | | | | | | |

|other income,” below) | | | | | | |

| | | | |Other: | | |

|Total |$ |$ |$ |Total |$ |$ |

* Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.

|Describe Other Income |Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower (B) or |

| |Co-Borrower (C) does not choose to have it considered for repaying this loan. |

|B/C | |Monthly Amount |

| | |$ |

| | | |

| | | |

| | | |

|VI. ASSETS AND LIABILITIES |

This Statement and any applicable supporting schedules may be completed jointly by both married and unmarried Co-Borrowers if their assets and liabilities are sufficiently joined so that the Statement can be meaningfully and fairly presented on a combined basis; otherwise, separate Statements and Schedules are required. If the Co-Borrower section was completed about a non-applicant spouse or other person, this Statement and supporting schedules must be completed about that spouse or other person also.

Completed Jointly Not Jointly

|ASSETS |Cash or |Liabilities and Pledged Assets. List the creditor’s name, address, and account number for |

| |Market Value |all outstanding debts, including automobile loans, revolving charge accounts, real estate |

|Description | |loans, alimony, child support, stock pledges, etc. Use continuation sheet, if necessary. |

| | |Indicate by (*) those liabilities, which will be satisfied upon sale of real estate owned or|

| | |upon refinancing of the subject property. |

|Cash deposit toward purchase held by: |$ |LIABILITIES |Monthly Payment & |Unpaid Balance |

| | | |Months Left to Pay | |

|List checking and savings accounts below |Name and address of Company |$ Payment/Months |$ |

|Name and address of Bank, S&L, or Credit Union | | | |

| |Acct. no. | | |

|Acct. no. |$ |Name and address of Company |$ Payment/Months |$ |

| | | | | |

|VI. ASSETS AND LIABILITIES (cont’d) |

|Name and address of Bank, S&L, or Credit Union |Acct. no. | | |

| | | | |

|Acct. no. |$ |Name and address of Company |$ Payment/Months |$ |

|Name and address of Bank, S&L, or Credit Union | | | |

| |Acct. no. | | |

|Acct. no. |$ |Name and address of Company |$ Payment/Months |$ |

|Name and address of Bank, S&L, or Credit Union | | | |

| |Acct. no. | | |

|Acct. no. |$ |Name and address of Company |$ Payment/Months |$ |

|Stocks & Bonds (Company name/number & |$ | | | |

|description) | | | | |

| | | | | |

| | |Acct. no. | | |

|Life insurance net cash value |$ |Name and address of Company |$ Payment/Months |$ |

| | | | | |

|Face amount: $ | | | | |

|Subtotal Liquid Assets |$ |Acct. no. | | |

|Real estate owned |$ |Alimony/Child Support/Separate |$ |$ |

|(enter market value from schedule of | |Maintenance Payments Owned to: | | |

|real estate owned) | | | | |

|Vested interest in retirement fund |$ | | | |

|Net worth of business(es) owned |$ |Job-Related Expense |$ | |

|(attach financial statement) | |(child care, union dues, etc.) | | |

|Automobiles owned |$ | | | |

|(make and year) | | | | |

| | | | | |

|Other Assets (itemize) |$ | | | |

| | | | | |

| | | | | |

| | |Total Monthly Payments |$ | |

|Total Assets |$ |Net Worth |$ |Total Liabilities |$ |

|a. | |(a minus b) | |b. | |

| | | | | | |

Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet.)

|Property Address (enter S if |Type of |Present |Amount |Gross |Mortgage |Insurance, |Net Rental |

|sold, PS if pending sale or R |Property |Market Value |of Mortgages |Rental Income |Payments |Maintenance, Taxes &|Income |

|if rental being held for | | |& Liens | | |Misc. | |

|income) | | | | | | | |

| | | |$ |$ |$ |$ |$ |$ |

| | | | | | | | | |

| | | | | | | | | |

| |Totals |$ |$ |$ |$ |$ |$ |

List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s):

|Alternate Name |Creditor Name |Account Number |

| | | |

|VII. DETAILS OF TRANSACTION |VIII. DECLARATIONS |

|a. |Purchase price |$ |If you answer “Yes” to any questions a through i, please |Borrower |Co-Borrower |

| | | |use continuation sheet for explanation. | | |

|b. |Alterations, improvements, repairs| | |Yes |No |Yes |No |

|c. |Land | |Are there any outstanding judgments against you? | | | | |

| |(if acquired separately) | | | | | | |

|d. |Refinance | |Have you been declared bankrupt within the past 7 years? | | | | |

| |(incl. debts to be paid off) | | | | | | |

|e. |Estimated prepaid items | |Have you had property foreclosed upon or given title or| | | | |

| | | |deed in lieu thereof in the last 7 years? | | | | |

|f. |Estimated closing costs | |Are you a party to a lawsuit? | | | | |

|g. |PMI, MIP, Funding Fee | |Have you directly or indirectly been obligated on any | | | | |

| | | |loan of which resulted in foreclosure, transfer of title | | | | |

| | | |in lieu of foreclosure, or judgment? | | | | |

| | | | | | | | |

| | | |(This would include such loans as home mortgage loans, SBA| | | | |

| | | |loans, home improvement loans, educational loans, | | | | |

| | | |manufactured (mobile) home loans, any mortgage, financial | | | | |

| | | |obligation, bond, or loan guarantee. If “Yes,” provide | | | | |

| | | |details, including date, name, and address of Lender, FHA | | | | |

| | | |or VA case number, if any, and reasons for the action.) | | | | |

|h. |Discount | |Are you presently delinquent or in default on any Federal| | | | |

| |(if Borrower will pay) | |debt or any other loan, mortgage, financial obligation, | | | | |

| | | |bond, or loan guarantee? | | | | |

| | | |If “Yes,” give details as described in the preceding | | | | |

| | | |question. | | | | |

|i. |Total costs | |Are you obligated to pay alimony, child support, or | | | | |

| |(add items a through h) | |separate maintenance? | | | | |

| j. |Subordinate financing | |Is any part of the down payment borrowed? | | | | |

|VII. DETAILS OF TRANSACTION (cont’d) |VIII. DECLARATIONS (cont’d) |

|k. |Borrower’s closing costs paid by | |Are you a co-maker or endorser on a note? | | | | |

| |Seller | | | | | | |

|l. |Other Credits (explain) | |------------------------------------------------------- | | | | |

| | | |Are you a U.S. citizen? | | | | |

| | | |Are you a permanent resident alien? | | | | |

|m. |Loan amount (exclude PMI, MIP, | |Do you intend to occupy the property as your primary | | | | |

| |Funding Fee financed) | |residence? | | | | |

| | | |If “Yes,” complete question m below. | | | | |

|n. |PMI, MIP, Funding Fee financed | |Have you had an ownership interest in a property in the | | | | |

| | | |last three years? | | | | |

|o. |Loan amount | | (1) What type of property did you own—principal |___ |___ |___ |___ |

| |(add m & n) | |residence (PR), second home (SH), or investment property | | | | |

| | | |(IP)? | | | | |

|p. |Cash from/to Borrower | | (2) How did you hold title to the home— by yourself (S),|___ |___ |___ |___ |

| |(subtract j, k, l & o from i) | |jointly with your spouse or jointly with another person | | | | |

| | | |(O)? | | | | |

|ACKNOWLEDGMENT AND AGREEMENT |

Each of the undersigned specifically represents to Lender and to Lender's actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors and assigns and agrees and acknowledges that: (1) the information provided in this application is true and correct as of the date set forth opposite my signature and that any intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Sec. 1001, et seq.; (2) the loan requested pursuant to this application (the "Loan") will be secured by a mortgage or deed of trust on the property described in this application; (3) the property will not be used for any illegal or prohibited purpose or use; (4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan; (5) the property will be occupied as indicated in this application; (6) the Lender, its servicers, successors or assigns may retain the original and/or an electronic record of this application, whether or not the Loan is approved; (7) the Lender and its agents, brokers, insurers, servicers, successors, and assigns may continuously rely on the information contained in the application, and I am obligated to amend and/or supplement the information provided in this application if any of the material facts that I have represented should change prior to closing of the Loan; (8) in the event that my payments on the Loan become delinquent, the Lender, its servicers, successors or assigns may, in addition to any other rights and remedies that it may have relating to such delinquency, report my name and account information to one or more consumer reporting agencies; (9) ownership of the Loan and/or administration of the Loan account may be transferred with such notice as may be required by law; (10) neither Lender nor its agents, brokers, insurers, servicers, successors or assigns has made any representation or warranty, express or implied, to me regarding the property or the condition or value of the property; and (11) my transmission of this application as an "electronic record" containing my "electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this application containing a facsimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature.

Acknowledgement. Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or reverify any information contained in this application or obtain any information or data relating to the Loan, for any legitimate business purpose through any source, including a source named in this application or a consumer reporting agency.

|Borrower’s Signature |Date |Co-Borrower’s Signature |Date |

|X | |X | |

| X. INFORMATION FOR GOVERNMENT MONITORING PURPOSES |

The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)

|BORROWER |CO-BORROWER |

|I do not wish to furnish this information |I do not wish to furnish this information |

|Ethnicity: Hispanic or Latino |Ethnicity: Hispanic or Latino |

|Not Hispanic or Latino |Not Hispanic or Latino |

|Race: | American Indian or Alaska Native |Race: | American Indian or Alaska Native |

| |Asian | |Asian |

| |Black or African American | |Black or African American |

| |Native Hawaiian or Other Pacific Islander | |Native Hawaiian or Other Pacific Islander |

| |White | |White |

|Sex: Female Male |Sex: Female Male |

|To be Completed by Loan Originator |

|This information was provided: |

|In a face-to-face interview |

|In a telephone interview |

|By the applicant and submitted by fax or mail |

|By the applicant and submitted via e-mail or the Internet |

|Loan Originator’s Signature |Date |

|Loan Originator’s Name (print or type) |Loan Originator Identifier |Loan Originator’s Phone Number (including area |

| | |code) |

| | | |

| | | |

|Loan Origination Company’s Name |Loan Origination Company Identifier |Loan Origination Company’s Address |

| | | |

| | | |

| | | |

|CONTINUATION SHEET/RESIDENTIAL LOAN APPLICATION |

|Use this continuation sheet if you need more |Borrower: |Agency Case Number: |

|space to complete the Residential Loan | | |

|Application. Mark B for Borrower or C for | | |

|Co-Borrower. | | |

| | | |

| |Co-Borrower: |Lender Case Number: |

| | | |

____________________________________________________________________________________________

I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of Title 18, United States Code, Section 1001, et seq.

|Borrower’s Signature |Date |Co-Borrower’s Signature |Date |

|X | |X | |

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